The mission of Prognosis is to explore the nexus at which healthcare policy meets healthcare practice and how one affects the other. This blog makes readers more aware of the innovations taking place in healthcare delivery, financing and technology and the types of public policies that will encourage further progress.

Healthcare In Focus is a public education initiative of the HLC, created to promote a constructive dialogue about the state and future of American healthcare.

Some ideas on Capitol Hill make so much sense that you can’t help but wonder why they haven’t become law already.

But, then again, tort reform has proven many times to be the legislative swamp where good ideas go to die.

This week, the House Energy and Commerce Committee passed a measure that would have the federal government provide medical liability coverage to physicians who volunteer their time at free clinics or community health centers. Current law, the Federal Tort Claims Act, provides malpractice coverage to community health center employees, but not to volunteering physicians.

When doctors have to pay their own extensive liability coverage for doing a good deed and bringing their services to a community health center, it’s no wonder that many can’t afford to do so.

The bipartisan authors of the Family Health Care Accessibility Act that won House Energy and Commerce passage, Representatives Gene Green (D-TX) and Tim Murphy (R-PA), say extending liability protections would let physicians provide coverage to 20 million Americans, 70 percent of them below the poverty line.

Legislation like this is particularly important when you consider that the number of people receiving care from community health centers is expected to double to 40 million by 2015.

This bill has been introduced twice in the last two years and failed to make it to the finish line both times. In 2008, it was cut from a community health center reauthorization bill in conference committee. Last year, it was incorporated into the House’s version of health reform legislation but not the Senate’s, and it was the Senate bill that went to the President this spring.

Anytime you get into tort reform issues, it becomes a sticky, sensitive political matter. On this legislation, though, it’s hard to make an argument that the medical liability status quo should stay intact if it means denying care to some of America’s most vulnerable citizens.

I just came across an interview last week in the Indianapolis Star with Eli Lilly and Company CEO John Lechleiter. It’s a q-and-a that is particularly interesting because Mr. Lechleiter shares his perspectives on, among other topics, the greatest challenges facing the pharmaceutical industry and the future of innovation in the United States.

I encourage Prognosis readers to check out the full article, but here are a few of Mr. Lechleiter’s illuminating quotes:

On progress against cancer…

“Many people who study the treatment of cancer today believe that, for some types of cancer, we may be able to keep patients sort of static. While the cancer may not be cured, it is not progressing, and the patient is able to do better for longer periods of time.”

On China as a marketplace…

“We see much evidence of progress…if we look at all the things that have been done within China to modernize the health system and healthcare delivery….We see China emerging as the second-leading pharmaceutical market probably by the end of this decade.”

On how the U.S. can remain a leader in innovation…

“We’re falling behind with respect to science and math aptitude among grade school, high school students. We also need to expand the number of visas…to non-U.S. citizens who want to stay in this country and work in these high-tech industries and startup companies. And we need sustained investment by the U.S. government in basic research.”

Some bad ideas, no matter how firmly they are rejected, just refuse to go away. Like Dracula, they continue to rise from the dead. The so-called public option for health insurance is one such ill-conceived concept that keeps clinging to life.

Here’s the latest. The Congressional Budget Office was requested to analyze a proposal in which a government-run health plan would be added to the health insurance exchanges that will be created under the new health reform law, the Patient Protection and Affordable Care Act. CBO came back with a finding that doing so would reduce federal deficits through 2019 by about $53 billion — $37 billion through reduced subsidies to exchange participants because they would be selecting the lower-priced government plan and $26 billion in increased tax revenues because a greater share of employee compensation would be in the form of wages and salaries instead of non-taxable health benefits.

Noam Levey, the excellent health policy reporter for the Los Angeles Times, wrote this week that, with the CBO report in hand, 128 members of the House of Representatives are pushing to reconsider the public option idea that was cast aside during the health reform debate. The rallying cry for resurrecting the public option is now deficit reduction.

No matter what rationale is used, though, for advocating a public option, the fatal flaw in the argument remains the same.

A government-run health plan does not save money through some mystical efficiencies that private plans can’t find. It simply pays physicians and hospitals less money. Medicare and Medicaid pay providers less than the actual cost of providing care. They make up that shortfall by shifting costs over to private payers, thus increasing healthcare costs for employers and individual health insurance purchasers.

CBO estimates 13 million people would opt for the government-run health insurance plan. Public option advocates say the end result will be lower deficits and reduced consumer costs. But they know better. It’s not a reduced cost burden. It’s a transference of that burden to private payers.

CBO’s report doesn’t change the fact that the public option is just as bad an idea now as it was during the health reform debate. Can we please just put a stake in this thing?

Yesterday, the Arkansas surgeon general told a state legislative committee that the state’s physician shortage would be worsening once health reform is implemented. Dr. Joe Thompson testified that 80 to 90 percent of Arkansas’ 500,000 uninsured residents will become newly insured, most of them through an expansion of the Medicaid program. He emphasized that the state already has severe doctor shortages in its rural areas.

At the same time, Physicians News Digest is quoting a report by the New Jersey Council of Teaching Hospitals which projects that New Jersey will have a shortage of approximately 2,800 physicians (and as many as 3,250) by the year 2020. In New Jersey, health reform will add roughly 1.3 million patients to the newly-insured rolls. The Council projects severe shortages in primary care as well as neurosurgery and pediatric subspecialties.

We’re going to be hearing more warnings like these, most likely from every state. There’s no debating that addressing the uninsured problem in America is a good and necessary thing. But, we can’t be complacent in believing that expanded coverage necessarily leads to expanded access. It’s quite clear that our rapid increase in covered individuals is going to outpace the supply of physicians, nurses and other healthcare professionals able to provide care. As policymakers revisit health reform, which it inevitably will, addressing these shortages has to be an urgent priority.

Two news stories this week raise serious concerns about the effectiveness of systems intended to act upon physicians and nurses who don’t meet adequate standards for providing patient care.

• A Massachusetts General Hospital survey of more than 3,000 physicians across multiple specialties found that one of every three doctors rejected the idea that they should report colleagues who are incompetent or impaired by substance abuse or mental health problems. The survey found that 17 percent of doctors had encountered a physician who was either incompetent or impaired, but only two-thirds of those doctors turned in their colleague.

• In today’s USA Today, it was reported that nurses who have committed acts of misconduct in some states can easily get jobs in other states that are part of a multi-state compact aimed at getting nurses into regions that need them the most. The news article cited a nurse in Wisconsin who was fired for stealing narcotics, but still maintained a clean record in the eyes of the multi-state compact and was able to easily get another nursing job in North Carolina.

I don’t want to oversimplify these issues. Certainly, it is difficult for physicians, in order to maintain open lines of communication and collaboration, to “snitch” on a colleague who has an addiction problem or who may even be suffering early signs of dementia. And, for nurses, the idea of multi-state cooperation is a good one because innovative steps need to be taken to address the nursing shortages that exist in so many parts of the country.

In the end, though, the patient has to come first, and patients can’t be put at risk by any lessening of standards when it comes to the quality of physicians and nurses. There is a need here for associations representing both professions to be proactive in ensuring that all members in their ranks meet the highest standards.